| NPI | 1780792424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 0958) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 0958) | |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2012-07-18 |