| NPI | 1396712071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2000171097) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1190) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2024-02-13 |