| NPI | 1699909127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 601) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NM 095493) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2009-11-24 |