| NPI | 1366780454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: HI 941) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM 1262) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2015-07-16 |