| NPI | 1093251662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 3629) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 8.003629) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2017-01-09 |