| NPI | 1154579035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 537) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| 103TH0100X Psychologist, Health Service (Licence: GA PSY000984) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2008-09-03 |