| NPI | 1083718290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS LP1343) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO PY01747) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2014-11-20 |