| NPI | 1346585023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AK 158904) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY.0004593) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2022-08-18 |