| NPI | 1225408941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60427281) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015520) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |