| NPI | 1144428855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3208) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL SS 903) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2020-09-01 |