| NPI | 1033457981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 1873) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MA 1873) |
| 103TF0200X Psychologist, Forensic (Licence: CA 6350) | |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2013-01-28 |