| NPI | 1073616967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: DE B1-0000172) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DE B0000172) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2019-01-29 |