| NPI | 1093762536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 8832) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 03942) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2015-04-28 |