| NPI | 1952399289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PSY 054) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PL 4851) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2007-10-02 |