| NPI | 1932371978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL 692682796) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL 692682798) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2016-05-31 |