| NPI | 1861580821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL LPY19) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301006498) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2018-10-25 |