| NPI | 1619105368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04651) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004116) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2011-12-30 |