NPI | 1174525653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NE 554) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NE 554) |
Enumeration Date | 2005-08-15 |
Last Update Date | 2024-03-19 |