| NPI | 1770697369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY849) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 01248) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-11-20 |