| NPI | 1992859664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ND 454) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 1087) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2012-03-01 |