| NPI | 1336352194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 0815) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 0815) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: OR 0815) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2010-12-20 |