| NPI | 1043300361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY6469) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS004089L) |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2007-07-08 |