NPI | 1083070536 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810005353) |
Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: VA 0810005353) |
Enumeration Date | 2016-01-13 |
Last Update Date | 2021-07-26 |