| NPI | 1407932791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: IN WAIVER CERTIFICATION) |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2007-07-09 |