| NPI | 1578647004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2320) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 2320) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 2320) | |
| 103TF0000X Psychologist, Family (Licence: WI 2320) | |
| 103TF0200X Psychologist, Forensic (Licence: WI 2320) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2010-09-28 |