| NPI | 1790783868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 1056) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY0765) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2017-11-02 |