| NPI | 1275991028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 1050) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 3198) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2016-02-08 |