| NPI | 1982846671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY001114) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 34022) |
| 103TC0700X Psychologist, Clinical (Licence: MS 45-727) | |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2015-10-16 |