| NPI | 1518920313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY000.4998) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS--008851-L) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.007585) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2020-07-23 |