NPI | 1083277339 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361007731) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301017702) |
Enumeration Date | 2019-04-22 |
Last Update Date | 2022-09-28 |