| NPI | 1639244171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 002603) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 002603) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2018-12-28 |