| NPI | 1598858607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO PSY1093) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: KS LCP317) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-09 |