| NPI | 1255502472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 2006020048) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: RI PS00705) |
| Enumeration Date | 2008-03-15 |
| Last Update Date | 2008-03-15 |