| NPI | 1386899086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 001024) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 3564) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2017-01-11 |