| NPI | 1598389140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3622) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY10759) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2023-01-17 |