NPI | 1346585023 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AK 158904) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY.0004593) |
Enumeration Date | 2012-12-06 |
Last Update Date | 2022-08-18 |