| NPI | 1740256163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ND 201) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ND 201) |
| Enumeration Date | 2006-02-25 |
| Last Update Date | 2021-11-03 |