| NPI | 1609919612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 92-25P) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 21056) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |