| NPI | 1194041251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 2878) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 2878) |
| 103TH0100X Psychologist, Health Service (Licence: CO 2878) | |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2010-04-14 |