| NPI | 1821207234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 1831) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MD 1831) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |