| NPI | 1881672772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 2173) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NC 332) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2009-12-06 |