NPI | 1194338749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5718) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OK 5718) |
103TC2200X Psychologist Clinical Child & Adolescent (Licence: NC 5718) | |
103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NC 5718) | |
Enumeration Date | 2020-08-24 |
Last Update Date | 2020-08-24 |