| NPI | 1205327301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 10378) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 3628) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2018-05-23 |