| NPI | 1043513393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 721) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI PSY1140) |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2017-03-27 |