| NPI | 1609109586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SC 412) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 1289) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2013-11-08 |