| NPI | 1598814394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA 864) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: TN P001108) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |