| NPI | 1750311890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 000239) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA 239) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2016-03-23 |