| NPI | 1447685029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 3201-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1845) |
| 103TC0700X Psychologist, Clinical (Licence: MS 53 934) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.008706) | |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2015-12-08 |