| NPI | 1205991957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 002394) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 002394) |
| 103TF0200X Psychologist, Forensic (Licence: CT 002394) | |
| Enumeration Date | 2006-12-23 |
| Last Update Date | 2007-07-08 |