| NPI | 1699813055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY001830) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM 1052) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2017-03-11 |