NPI | 1124514369 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810007596) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 10855) |
Enumeration Date | 2018-07-10 |
Last Update Date | 2023-08-10 |