| NPI | 1255361002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1610-57) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WI 1610) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2023-08-09 |