| NPI | 1164710380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810005291) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 4068) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2015-10-23 |