| NPI | 1104071471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3976) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: AZ 3976) |
| Enumeration Date | 2008-11-29 |
| Last Update Date | 2018-03-17 |