| NPI | 1215055975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PSY142) |
| Additional Taxonomies | 251S00000X (Licence: NV PSY142) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2019-08-02 |