| NPI | 1972757532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1451) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 1791) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2008-11-10 |