| NPI | 1336334440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4010) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY4322) |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2010-01-29 |