| NPI | 1508975467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 1303) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO 1303) |
| 103TS0200X Psychologist, School (Licence: CO 0308917) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-09 |