| NPI | 1235159088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 000568) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CT 000568) |
| 103TS0200X Psychologist, School (Licence: CT 070) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-08 |