| NPI | 1881964526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1211) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 434) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2015-07-08 |