| NPI | 1891884177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 33504) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: TN 1738) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-07-07 |