| NPI | 1275543738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID Psy 418) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 4839092-2501) |
| 103TC0700X Psychologist, Clinical (Licence: GA 1804) | |
| 103TC0700X Psychologist, Clinical (Licence: FL 2689) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2007-07-08 |