| NPI | 1194247254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DE B1-0000360) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000360) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2025-10-13 |