| NPI | 1225240153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 02759) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810002616) |
| 103TH0100X Psychologist, Health Service (Licence: MD 02759) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2014-06-04 |