| NPI | 1124451653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2013032508) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1299) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2013-09-03 |