| NPI | 1306221411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA 003786) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4286) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-08-12 |