| NPI | 1811085376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2403) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NH 308) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-09 |