| NPI | 1598986465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY6018) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301011945) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-12-08 |