| NPI | 1952562274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL 8041) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 00663) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2020-07-06 |