| NPI | 1538126826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 0004932) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 567) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2019-02-21 |