| NPI | 1780784272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 2104) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: MA 2104) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2007-07-09 |