| NPI | 1497711899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1143-57) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1143-057) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2011-01-19 |