| NPI | 1518090604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY 266) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: ID PSY 266) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |