| NPI | 1215482658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 0001881) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CO 86896) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-08-15 |