| NPI | 1952491367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 0566) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO R0450) |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2018-09-24 |