| NPI | 1073731667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 841) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC 390) |
| 103T00000X Psychologist (Licence: MD 2083) | |
| 103T00000X Psychologist (Licence: VT 701) | |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2007-07-08 |