| NPI | 1720124290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: MA 09083) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 09083) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2012-07-06 |