| NPI | 1871709287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 436) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NH 436) |
| 103TC0700X Psychologist Clinical (Licence: NH 436) | |
| 103TH0004X Psychologist Health (Licence: NH 436) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |