| NPI | 1255585154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 1401) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 22260) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2017-05-08 |