NPI | 1316047061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MO PYR0366) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO PYR0366) |
103TF0000X Psychologist, Family (Licence: MO PYR0366) | |
Enumeration Date | 2006-09-23 |
Last Update Date | 2022-07-21 |