| NPI | 1528361292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NV PY0560) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NV PY0560) |
| 103TE1100X Psychologist Exercise & Sports (Licence: NV PY0560) | |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2010-12-17 |