| NPI | 1275769077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-004915) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP5181) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2019-11-18 |