| NPI | 1447359849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA PY2105PR) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 202) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2010-07-12 |