| NPI | 1750592267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 861) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MD 861) |
| 103TC0700X Psychologist Clinical (Licence: MD 861) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2015-04-02 |