| NPI | 1184956278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: CO 2187) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CO 2187) |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2010-02-01 |