| NPI | 1497900013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV 100) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN 748) |
| 103TC0700X Psychologist, Clinical (Licence: AZ 593) | |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2008-11-24 |