| NPI | 1831537307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 2563-057) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: WI 2563-057) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2013-06-06 |