NPI | 1316246937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3238) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005193) |
Enumeration Date | 2011-03-22 |
Last Update Date | 2025-05-13 |