| NPI | 1316189996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN 3529) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 4101) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2018-08-02 |