| NPI | 1295172179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: SC 121749) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 3020) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2013-06-03 |