| NPI | 1801042049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PYT141125) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY24004) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2014-11-29 |