| NPI | 1538487590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 532) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: MA 3270) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2010-05-13 |