NPI | 1073591178 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY2139) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY2139) |
Enumeration Date | 2006-01-09 |
Last Update Date | 2022-09-23 |