| NPI | 1134663370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2016039009) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 0004489) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2016-12-07 |