| NPI | 1326370859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY4721) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WV 254) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2010-02-09 |