| NPI | 1528137056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1805) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2005015536) |
| 103T00000X Psychologist (Licence: OK 994) | |
| 103T00000X Psychologist (Licence: CA PSY 19940) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2010-11-04 |