| NPI | 1417444746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS019183) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2020-12-23 |