| NPI | 1659652444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1209) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 5623685-2501) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2016-04-26 |