| NPI | 1962510883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 3258) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY6427) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-04-15 |