| NPI | 1306987045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC 1532) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 2529) |
| 103T00000X Psychologist (Licence: NC 1540) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 2182) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-07-08 |