| NPI | 1275674780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: HI 483) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 12865) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-07-08 |