| NPI | 1427464536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY004362) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 2014-52) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2023-08-20 |