NPI | 1013909506 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 951) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 23004) |
Enumeration Date | 2005-08-19 |
Last Update Date | 2023-03-02 |