| NPI | 1225170756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DE B1-0000610) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS006478L) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-09 |