| NPI | 1083772750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 883) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 1043460397) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2009-12-01 |