| NPI | 1699059550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 2601) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 2815) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2011-10-10 |