NPI | 1417298647 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2519) |
Additional Taxonomies | 103T00000X Psychologist (Licence: SC 1240) |
Enumeration Date | 2013-03-13 |
Last Update Date | 2025-03-27 |