| NPI | 1144252875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1699-057) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 1699-057) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2015-05-21 |