| NPI | 1568717908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 05527) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC 1001085) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2022-01-06 |