| NPI | 1538471735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016781) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY9472) |
| 103TC0700X Psychologist, Clinical (Licence: NY 007739-1) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2010-07-06 |