| NPI | 1891027819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4190) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DE B1-0000738) |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2022-10-18 |