| NPI | 1982624656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 197) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 2213) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-06-04 |