| NPI | 1720101926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC 1348) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 1700) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |