| NPI | 1962483206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: NC 5209) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 5209) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2020-01-17 |