| NPI | 1841547353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA psy003551) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 1169) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2012-08-14 |