| NPI | 1245397066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 1031) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 949) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2015-01-12 |