| NPI | 1003074741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OK 1143) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AR 07-37P) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2018-03-21 |