| NPI | 1356360036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 2007006356) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS015565) |
| 103TC0700X Psychologist Clinical (Licence: CA PSY18710) | |
| 103TC0700X Psychologist Clinical (Licence: WI 1866-057) | |
| 103TC0700X Psychologist Clinical (Licence: FL PY3870) | |
| 103TC0700X Psychologist Clinical (Licence: MN LP1049) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2010-02-17 |