| NPI | 1285648170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 1981) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC PP1981) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2022-10-25 |