| NPI | 1194043562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11303) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA PSY11303) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2024-04-19 |