| NPI | 1720116304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 1092) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1092) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2013-09-30 |