| NPI | 1114463072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 1277) |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2017-01-20 |