| NPI | 1053689356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY-282) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID PSY-282) |
| 103TC1900X Psychologist, Counseling (Licence: ID PSY-282) | |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2011-12-01 |