| NPI | 1174586697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ND 341) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: ND 341) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2023-03-01 |