| NPI | 1063710234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 1049) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CT 1049) |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2011-03-11 |