| NPI | 1558947887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY11278) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 06419) |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2023-12-27 |