| NPI | 1811965684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 46 803) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OK 417) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2008-02-19 |