NPI | 1487778973 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017780) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00360200) |
Enumeration Date | 2007-03-19 |
Last Update Date | 2022-02-07 |