| NPI | 1598962276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PY002510) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY6321) |
| 103TC0700X Psychologist, Clinical (Licence: AL 1165) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2007-07-08 |