| NPI | 1811992498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 640) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WI 640) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2017-12-15 |