| NPI | 1407821945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS003175L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA PS003175L) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2010-12-16 |