| NPI | 1386782290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 001760) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 001760) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2010-10-05 |