| NPI | 1083897425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 372) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: CO 372) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2007-12-07 |