| NPI | 1356676811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1866) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2008032449) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2013-03-19 |