NPI | 1437644879 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 6964) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 6964) |
Enumeration Date | 2018-06-27 |
Last Update Date | 2018-06-27 |