| NPI | 1316051774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY-3398) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO R0435) |
| 103T00000X Psychologist (Licence: KS 0880) | |
| 103T00000X Psychologist (Licence: WA 1285) | |
| 103T00000X Psychologist (Licence: MO PRY 0435) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2010-08-03 |