| NPI | 1750422770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 02811) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 17678) |
| 103T00000X Psychologist (Licence: DE B1-0000383) | |
| 103TS0200X Psychologist, School (Licence: VA 0803000091) | |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2011-11-04 |