| NPI | 1871044065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: LA 1383) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: LA 1383) |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2016-10-22 |