| NPI | 1770540742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 1407) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: OR 1704) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-10-09 |