| NPI | 1457682122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 9098) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 322113) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2014-09-09 |