| NPI | 1003835331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 7442) |
| 103TC0700X Psychologist Clinical (Licence: IN 20041825A) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |