| NPI | 1801117437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: LA 756) |
| Additional Taxonomies | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances (Licence: LA 756) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2010-06-24 |