| NPI | 1588662944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: NC 2426) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 1094) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2008-10-06 |