| NPI | 1316036668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 0571617) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 2553125) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-11 |