NPI | 1346815792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP8686) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY11126) |
Enumeration Date | 2021-05-26 |
Last Update Date | 2023-11-01 |