| NPI | 1144671884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY-203364) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 11022713-2501) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2021-05-04 |