| NPI | 1477784650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: UT 8483321-2501) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: AZ 4014728) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2022-05-27 |