| NPI | 1912916065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5414) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 934-057) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2021-09-15 |