| NPI | 1073124723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: DE B-10000458) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DE B-10000548) |
| 103T00000X Psychologist (Licence: DE B-10000458) | |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2020-08-14 |