| NPI | 1184961658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY001103) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA 1103) |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2018-02-20 |