NPI | 1043588098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: AL 1887) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 06917) |
Enumeration Date | 2011-12-06 |
Last Update Date | 2024-11-05 |