| NPI | 1912021569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2050) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 2050) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2022-01-20 |