| NPI | 1295724169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM NM572) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NM 572) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2025-10-22 |