| NPI | 1750645248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 001241) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 001241) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IA 001241) | |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2012-06-29 |