| NPI | 1649256405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 106369) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 106369) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2007-07-08 |