| NPI | 1326074279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 01567) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MO PY01567) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2018-09-25 |