| NPI | 1205449477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MD 55-0557) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |