| NPI | 1962711655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: NC 3943) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 3943) |
| 103T00000X Psychologist (Licence: AL 1496) | |
| 103TC0700X Psychologist Clinical (Licence: NC 3943) | |
| 103TC0700X Psychologist Clinical (Licence: AL 1496) | |
| 103TF0200X Psychologist Forensic (Licence: AL 1496) | |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2010-09-29 |