| NPI | 1760711683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 1176) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301001675) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2009-12-24 |