| NPI | 1689665937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 0814) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 0814) |
| 103TC1900X Psychologist, Counseling (Licence: OR 0814) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OR 0814) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2010-06-16 |