| NPI | 1467660803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 198) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 21363) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-05-13 |