| NPI | 1740251453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 1952) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: NC 1952) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-07-08 |