| NPI | 1891250270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 06037) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810006123) |
| Enumeration Date | 2019-02-10 |
| Last Update Date | 2019-02-10 |