NPI | 1376662247 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301010580) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301010580) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2024-11-20 |