| NPI | 1518193283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 739) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 3456) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2009-06-08 |