NPI | 1124149323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 686) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VT 048-0000565) |
Enumeration Date | 2007-04-03 |
Last Update Date | 2024-08-12 |