| NPI | 1114536554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: FL SS1179) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 477740) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2020-07-30 |