| NPI | 1801118815 |
|---|---|
| Former Name | JOHN M BOLES |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO R0518) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO R0518) |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2010-02-17 |