| NPI | 1194735100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 737) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NM 737) |
| 103TS0200X Psychologist, School (Licence: NM 737) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2011-11-03 |