| NPI | 1225090012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 1917) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1917) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-08-08 |