| NPI | 1245662741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 2383) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: OR 2383) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OR 2383) | |
| 103TF0000X Psychologist Family (Licence: OR 2383) | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2014-07-03 |