| NPI | 1104061902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 5506) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 2779) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2017-10-30 |