| NPI | 1780904516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 30591) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 11432) |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2010-06-03 |