| NPI | 1649324567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 287) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NM 098162) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-09 |