| NPI | 1821008947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 03502) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 03502) |
| 103TC1900X Psychologist Counseling (Licence: MA 03502) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2014-12-29 |