| NPI | 1790157469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3349-57) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP5932) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2021-05-19 |