| NPI | 1265558316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1578) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: OR 1578) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-06-21 |