| NPI | 1699869669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 0859) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 002612) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |