| NPI | 1275582868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1132) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: SC 374) |
| 103T00000X Psychologist (Licence: AZ 1659) | |
| 103TC0700X Psychologist Clinical (Licence: IL 71-3359) | |
| 103T00000X Psychologist (Licence: NC 2282) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2007-07-09 |