| NPI | 1306230388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 4014) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN 4828) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2015-03-26 |