NPI | 1154095065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362009339) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6361007778) |
Enumeration Date | 2021-08-04 |
Last Update Date | 2023-01-02 |