| NPI | 1164574307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-002096) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: AZ 2096) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2019-02-07 |