| NPI | 1306977426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2001003634) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS LP-0999) |
| 103TH0100X Psychologist, Health Service (Licence: MO 2001003634) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2013-04-16 |