| NPI | 1992965966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY6919) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA 887) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2008-06-13 |