NPI | 1124033824 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY004752) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3306) |
103TC0700X Psychologist, Clinical (Licence: VA 0810002866) | |
Enumeration Date | 2006-07-30 |
Last Update Date | 2024-01-29 |