| NPI | 1790776664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY-688) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: HI PSY-688) |
| 103TH0100X Psychologist, Health Service (Licence: HI PSY-688) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2015-07-31 |