| NPI | 1992798946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NH 381) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: ME 565) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2009-05-12 |