| NPI | 1790834109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1153-057) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1593-057) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2011-09-01 |