| NPI | 1740331156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 1120) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810002591) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2007-07-08 |