| NPI | 1407977937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 246) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AK 525) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |