NPI | 1194769117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS002796L) |
Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS002796L) |
103T00000X Psychologist (Licence: PA PS002796L) | |
Enumeration Date | 2006-06-16 |
Last Update Date | 2022-10-06 |