| NPI | 1639479926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY8121) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DE B116) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2010-11-02 |