| NPI | 1386983641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 4829) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9340346) |
| 163W00000X Registered Nurse (Licence: PR 19641) | |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2013-02-06 |