| NPI | 1780701771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 671) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: MO 01279) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2016-12-28 |