| NPI | 1740340751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC 000031) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810003228) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |