| NPI | 1679988752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY003675) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: GA PSY003675) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2019-01-02 |