| NPI | 1225192479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY002625) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: GA PSY002625) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-09-18 |