| NPI | 1134431794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 1039) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AL 1597) |
| Enumeration Date | 2010-07-11 |
| Last Update Date | 2012-03-08 |