NPI | 1316108665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3572) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: AZ 3572) |
Enumeration Date | 2008-06-19 |
Last Update Date | 2020-03-25 |