| NPI | 1033358981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: WY CSSP04) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: WY CSSP04) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2009-02-17 |