| NPI | 1285755918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3303) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 1475) |
| 103T00000X Psychologist (Licence: NM 694) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-11-11 |