| NPI | 1760544688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 873) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NH 611) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2007-07-08 |