| NPI | 1174659288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 1817) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1630) |
| 103TC0700X Psychologist, Clinical (Licence: WY 214) | |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2007-07-08 |