| NPI | 1902900228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL py6707) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 007727) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2010-12-27 |