NPI | 1285302372 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35091) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 024445) |
Enumeration Date | 2021-09-02 |
Last Update Date | 2024-09-03 |