| NPI | 1740431030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 2984) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: PR 2984) |
| Enumeration Date | 2008-10-04 |
| Last Update Date | 2009-06-19 |