| NPI | 1104930114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: FL SS881) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2008-03-17 |