| NPI | 1649604729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11185) |
| Additional Taxonomies | 103T00000X Psychologist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2019-11-30 |