| NPI | 1447477047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810003815) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 3514) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-05-12 |