| NPI | 1962543488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 383) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SD 273) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2018-11-26 |