NPI | 1306101100 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 1000531) |
Additional Taxonomies | 103T00000X Psychologist (Licence: DC 1000531) |
Enumeration Date | 2012-07-08 |
Last Update Date | 2024-10-08 |