| NPI | 1740680289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 10509) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL 11027) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2022-08-18 |