| NPI | 1558672477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY 7475) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 071.007273) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2019-03-11 |