NPI | 1275769077 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-004915) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP5181) |
Enumeration Date | 2009-06-08 |
Last Update Date | 2019-11-18 |