| NPI | 1306127048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 1235) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 33260) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2017-04-19 |