| NPI | 1356511562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WY 125) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 6317857-2501) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2008-03-04 |