| NPI | 1447267067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 6191) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 6191) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2022-02-14 |