| NPI | 1851365860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN 4056) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 2114) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2022-07-21 |