| NPI | 1447480538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: AZ 524) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: NV 131) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2009-07-23 |