| NPI | 1972608842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 02874) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B10000344) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-16 |