| NPI | 1316047244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 7575) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 7575 PR) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2014-06-03 |