| NPI | 1902939135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 001057) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1160) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2016-08-05 |