| NPI | 1831360148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 2939) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: PR 2939) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |