| NPI | 1851819361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MA 53974349) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL 1260073) |
| 103TS0200X Psychologist, School (Licence: CT C072015000689) | |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2022-07-21 |