| NPI | 1225076888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY0002667) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL Py2667) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2012-06-20 |