| NPI | 1982691960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 4) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: NE 4) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NE 4) | |
| 103TC0700X Psychologist, Clinical (Licence: NE 4) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: NE 4) | |
| 103TF0000X Psychologist, Family (Licence: NE 4) | |
| 103TH0100X Psychologist, Health Service (Licence: NE 4) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2007-07-08 |