| NPI | 1275847329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2622-57) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103T00000X Psychologist (Licence: IA 001104) | |
| Enumeration Date | 2010-07-31 |
| Last Update Date | 2022-05-11 |