| NPI | 1073614111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 837) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 384) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |