NPI | 1083385595 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-005493) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
Enumeration Date | 2021-09-23 |
Last Update Date | 2022-04-14 |