| NPI | 1306226675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WY 608) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME PS1505) |
| 103T00000X Psychologist | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2017-04-21 |