NPI | 1578816245 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361006597) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015331) |
103TC0700X Psychologist, Clinical (Licence: MI 6301015331) | |
Enumeration Date | 2012-10-18 |
Last Update Date | 2020-07-06 |