| NPI | 1013464676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: SD 69019-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: SD 69019-1) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |