| NPI | 1811089618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 2798) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AL 1183) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2015-02-26 |