| NPI | 1841341963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005113) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3136) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2015-01-06 |