| NPI | 1659431153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: IA 00028) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IA 00028) |
| 103TC1900X Psychologist Counseling (Licence: IA 00028) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |