| NPI | 1487696308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 518) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 518) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2013-02-20 |