NPI | 1225374309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 567) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WY WY567) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-12-18 |
Last Update Date | 2021-04-15 |