| NPI | 1457600363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2815) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: OR 22583) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2022-07-21 |