| NPI | 1871773051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 845) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: 5977) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2009-04-21 |