| NPI | 1740374438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 6173) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WV 596) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-10-28 |