| NPI | 1316099757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: MA 1694) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 1694) |
| 103TF0200X Psychologist, Forensic (Licence: MA 1694) | |
| 103T00000X Psychologist (Licence: MA 1694) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |