| NPI | 1265632244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00002833) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 1485) |
| 103TC0700X Psychologist, Clinical (Licence: IL 71-002164) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2011-05-24 |