| NPI | 1821087396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 4546) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 002545) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2007-07-09 |