| NPI | 1720385289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA 911) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NM 1085) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2011-02-21 |