| NPI | 1225172786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT CT0001489) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT CT0001489) |
| 103T00000X Psychologist (Licence: CT CT001489) | |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2007-07-09 |