| NPI | 1790701696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 0747) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 01197) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2015-01-20 |