| NPI | 1437828043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3979) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS019865) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2024-07-22 |