| NPI | 1306995436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 7181) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 202250) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-09 |