| NPI | 1003284274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AR 1810AP-PL) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2018-10-31 |