| NPI | 1689683773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: DC 1903) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 03249) |
| Enumeration Date | 2006-08-06 |
| Last Update Date | 2014-04-15 |