| NPI | 1528166428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DE B10000348) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS005253L) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2012-08-14 |