| NPI | 1801991195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 860) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 01582) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2008-10-03 |