| NPI | 1073556742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA 1369) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: OR 576) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-07-08 |