| NPI | 1598721557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS LP991) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY4521) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2016-07-12 |