| NPI | 1437328440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2453) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NC 2453) |
| Enumeration Date | 2008-02-23 |
| Last Update Date | 2008-02-23 |