| NPI | 1558793729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 1058) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: SC 1058) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2014-06-24 |