| NPI | 1487199949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: UT 10187979-2501) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2017-02-09 |