NPI | 1386136356 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10936) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 06054) |
Enumeration Date | 2018-06-05 |
Last Update Date | 2023-11-15 |