NPI | 1053486142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301005034) |
Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301005034) |
103TA0700X Psychologist Adult Development & Aging (Licence: MI 6301005034) | |
103TF0000X Psychologist Family (Licence: MI 6301005034) | |
103TF0200X Psychologist Forensic (Licence: MI 6301005034) | |
103TF0200X Psychologist Forensic | |
103T00000X Psychologist (Licence: MI 6301005034) | |
Enumeration Date | 2006-11-22 |
Last Update Date | 2019-12-27 |