| NPI | 1770884512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MT 403) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA psy10081) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2010-11-10 |