| NPI | 1750521258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: OR 1792) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2009-02-24 |