| NPI | 1659479566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 01668) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 0862) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2014-02-26 |