| NPI | 1689793556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DE B1-0011356) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 02834) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2023-08-07 |