NPI | 1073627477 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 24013) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TX 24013) |
Enumeration Date | 2006-08-19 |
Last Update Date | 2022-06-29 |