| NPI | 1548598022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 724) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002595) |
| Enumeration Date | 2009-11-22 |
| Last Update Date | 2009-11-22 |