| NPI | 1134278179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NM 0953) |
| Additional Taxonomies | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NM 0953) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-09 |