| NPI | 1558425801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 01129) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: MO PY01129) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2019-10-25 |