| NPI | 1003166323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 1263) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 9891) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2014-08-13 |