| NPI | 1407095284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL 3193) |
| Additional Taxonomies | 103TH0004X Psychologist Health (Licence: FL 3193) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2009-02-18 |