| NPI | 1760782734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PY0510) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 17964) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2010-10-25 |