| NPI | 1396899100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC #3120) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 3989) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |