| NPI | 1962711960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301005015) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI CC-0C1870539340) |
| Enumeration Date | 2010-09-25 |
| Last Update Date | 2010-09-25 |