NPI | 1073616967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000172) |
Additional Taxonomies | 103T00000X Psychologist (Licence: DE B0000172) |
Enumeration Date | 2006-09-06 |
Last Update Date | 2019-01-29 |