NPI | 1316969538 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO R0408) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MO R0408) |
Enumeration Date | 2006-07-24 |
Last Update Date | 2022-10-05 |