| NPI | 1306118948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3270) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 2509) |
| Enumeration Date | 2012-01-28 |
| Last Update Date | 2017-05-31 |