| NPI | 1154497576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 474) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4451) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-09 |