| NPI | 1013952134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY-202376) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1234) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2009-02-12 |