NPI | 1154434413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN 2490) |
Additional Taxonomies | 103T00000X Psychologist (Licence: TN P0000002490) |
Enumeration Date | 2006-08-17 |
Last Update Date | 2021-12-14 |