NPI | 1376862037 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5426) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60778412) |
Enumeration Date | 2010-05-20 |
Last Update Date | 2019-02-21 |