NPI | 1326267121 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361004793) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MI 4101006301) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2022-08-06 |