| NPI | 1427184605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WY 199) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 1751) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2007-07-08 |