NPI | 1457768871 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P3339) |
Additional Taxonomies | 103T00000X Psychologist (Licence: TN P3339) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 6301015949) | |
Enumeration Date | 2014-07-17 |
Last Update Date | 2024-09-16 |