| NPI | 1801814686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1361057) |
| Additional Taxonomies | 103TH0004X Psychologist Health (Licence: WI 1361-057) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2010-07-09 |