| NPI | 1548402902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 2590) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC 10000147) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2009-04-01 |