| NPI | 1255410247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 202) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: WV 22004) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2008-11-17 |