| NPI | 1740399666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA Psychologist 3144) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA Psychologist 3144) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-12-20 |