| NPI | 1750481214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 3875) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MA 3875) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2012-07-11 |