| NPI | 1336297571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 001974) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA GAPSY001974) |
| Enumeration Date | 2007-01-06 |
| Last Update Date | 2008-11-20 |