| NPI | 1093229247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: MO 2017002014) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2017002014) |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2017-11-27 |