| NPI | 1821174301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 1999140253) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2008-02-13 |