NPI | 1013436567 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3027) |
Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY9989) |
Enumeration Date | 2017-09-15 |
Last Update Date | 2025-08-18 |