| NPI | 1861780371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: AL 2045) |
| Additional Taxonomies | 103T00000X Psychologist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2024-01-26 |