| NPI | 1245274885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 9362) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 002580) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2018-09-26 |