NPI | 1356792584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 10476) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MA 10476) |
103TC0700X Psychologist, Clinical (Licence: MA TBD) | |
Enumeration Date | 2016-06-29 |
Last Update Date | 2020-09-02 |