| NPI | 1255463477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AR 003P) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: AR 003P) |
| 103TH0100X Psychologist Health Service (Licence: AR 003P) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: AR 003P) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-08 |