| NPI | 1891767950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY2940) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WY 253) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2013-02-06 |