| NPI | 1770899338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: DC 1000621) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 081004014) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2010-08-20 |