| NPI | 1851722706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2353) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY003158) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2014-03-03 |