| NPI | 1619165206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO R0332) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 841) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2008-01-09 |