| NPI | 1215094917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 1538-057) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20041542) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |