| NPI | 1699717348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1914-057) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-005064) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2007-07-12 |