| NPI | 1225529043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 1525) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4749-PY-PY) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2018-05-29 |