| NPI | 1306124177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 7567) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.008774) |
| 103T00000X Psychologist | |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2018-03-17 |