| NPI | 1063443729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ND 208) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP4440) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2012-07-17 |