| NPI | 1952453524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 240) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: WV 240) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |