| NPI | 1134205404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DE B10000196) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS004021L) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2011-02-11 |