| NPI | 1013247097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY-203139) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MT 972) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2022-03-14 |