| NPI | 1558456491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 394) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AL 1014) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2014-07-11 |