| NPI | 1902816234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0005592) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301007494) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2026-08-05 |