| NPI | 1477993178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: NY 749032131) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 021801) |
| 103T00000X Psychologist (Licence: WA PY60632239) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2019-10-23 |