| NPI | 1881673598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: SD 381) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 4451) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2022-07-21 |