| NPI | 1447341565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 6096) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 694) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-12-02 |