| NPI | 1215605811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DE B1-0011522) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS019262) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2025-07-08 |