| NPI | 1427103886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 682) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: OR 682) |
| 103TF0200X Psychologist Forensic (Licence: OR 682) | |
| 103T00000X Psychologist (Licence: OR 682) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-09 |