| NPI | 1629137880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MT PSY-PSY-LIC 1484) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL py 3960) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2015-12-08 |