| NPI | 1679179667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY10934) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL 10934) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |