| NPI | 1619943735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 4996) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4996) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2010-08-05 |