| NPI | 1932698834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 2599) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 5229) |
| 103TH0100X Psychologist, Health Service (Licence: NC 5229) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2022-10-27 |