NPI | 1467128876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3991) |
Additional Taxonomies | 174400000X Specialist |
103TC0700X Psychologist, Clinical (Licence: CA 35135) | |
Enumeration Date | 2021-08-17 |
Last Update Date | 2025-08-07 |