NPI | 1467430207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 24810) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TX 4810) |
Enumeration Date | 2006-01-03 |
Last Update Date | 2025-01-24 |