| NPI | 1689994535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY2934) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: LA 1003) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2011-09-10 |