| NPI | 1114031820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM #0855) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 0855) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2009-08-25 |