| NPI | 1649225327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 5174) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: LA 888) |
| 103T00000X Psychologist (Licence: NC 5174) | |
| 103TC0700X Psychologist, Clinical (Licence: LA 888) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2018-07-06 |