| NPI | 1023229739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 2518) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: CO 2518) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CO 2518) | |
| 103TF0000X Psychologist Family (Licence: CO 2518) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |