| NPI | 1871501452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1320) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 1320-057) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2009-07-09 |