| NPI | 1497152557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: KS 2274) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 1308) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2015-03-10 |