| NPI | 1932845245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: FL PY11477) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MS 60-1050) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2022-05-10 |