| NPI | 1285049106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MA LEP # 607) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA DESE 251074) |
| 103TS0200X Psychologist, School (Licence: DC NCSP # 22370) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2014-06-30 |