| NPI | 1619046505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016091) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY17269) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |