| NPI | 1568523561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MT MTpscyhologist#100) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MT 100) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2009-07-30 |