| NPI | 1568538866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 2049) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 20497) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2018-01-29 |