| NPI | 1215081930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS1237) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NE 606) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2008-08-01 |