| NPI | 1417298647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2519) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 1240) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2025-03-27 |