| NPI | 1487934683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3056-57) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS017265) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2014-10-28 |