| NPI | 1851629844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 1844) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2009-12-02 |