| NPI | 1386010676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37060) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20041066A) |
| 103T00000X Psychologist (Licence: CA PSY9586) | |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2015-08-20 |