| NPI | 1730204579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 805) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA 805) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: GA 805) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2016-09-12 |