| NPI | 1548392129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AL 523) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AL 523) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AL 523) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2010-03-16 |