| NPI | 1033329305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 1000076) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 03678) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-11 |