| NPI | 1730260977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA 573) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OR 412) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-07-06 |