| NPI | 1689165151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: MA 2658) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 2658) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2018-05-21 |