| NPI | 1720242878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2008-07-17 |