NPI | 1225279623 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 22796) |
Additional Taxonomies | 103T00000X Psychologist (Licence: TX 22796) |
Enumeration Date | 2009-03-13 |
Last Update Date | 2022-03-30 |