| NPI | 1598926362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2002011102) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1256) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2012-09-05 |