| NPI | 1356453070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA PY 1900 PR) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MA PY 1900 PR) |
| 103T00000X Psychologist (Licence: MA PY 1900 PR) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-12-06 |