NPI | 1487856977 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: UT 94-266379-2501) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI 1483) |
103TC0700X Psychologist, Clinical (Licence: KS 2025) | |
103T00000X Psychologist (Licence: AZ 3226) | |
Enumeration Date | 2007-06-05 |
Last Update Date | 2024-09-11 |