| NPI | 1982707543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ND 167) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN 1453) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2022-07-21 |