| NPI | 1194826545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 1767-057) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1767-057) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2010-07-09 |