| NPI | 1750656815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PY0905) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 2870) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2022-12-09 |