| NPI | 1992947188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA PY 2173 PR) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA PY 2173 PR) |
| 103TF0200X Psychologist Forensic (Licence: MA PY 2173 PR) | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2011-09-28 |