| NPI | 1154474054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: OK 1466) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: OK 1466) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2024-09-25 |