| NPI | 1275746653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: AZ 835) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: PA PS008382L) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2010-06-22 |