| NPI | 1215134374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 1324) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 1324) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2009-05-18 |