| NPI | 1992946826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301007547) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007547) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2009-03-24 |