NPI | 1093368664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ AZ-005154) |
Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: AZ AZ-005154) |
Enumeration Date | 2019-07-22 |
Last Update Date | 2021-05-17 |