| NPI | 1649412883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1366) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 1366) |
| 103TC0700X Psychologist, Clinical (Licence: NC 1366) | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2009-04-02 |