| NPI | 1124356233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 4233) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MA 4233) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2012-04-27 |