NPI | 1487038972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017882) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS017882) |
Enumeration Date | 2015-07-14 |
Last Update Date | 2022-04-20 |