| NPI | 1932278041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00386) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 89) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2013-01-20 |