| NPI | 1801453477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-005446) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS018947) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2021-12-22 |