| NPI | 1023164209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PSY0485) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MS 9 132) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2007-07-08 |