NPI | 1467079046 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: TX 15541) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 6557) |
Enumeration Date | 2020-06-30 |
Last Update Date | 2023-11-08 |