| NPI | 1710971114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS LP 0773) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO R 0306) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2024-03-15 |