| NPI | 1275571960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2225) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2003023862) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-08-18 |