| NPI | 1568781847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017123) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6588) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2012-06-14 |