| NPI | 1366528648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 783) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: CO 783) |
| 103T00000X Psychologist (Licence: CO 783) | |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2007-07-08 |