NPI | 1578956132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY 60313079) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 013002-1) |
Enumeration Date | 2015-03-06 |
Last Update Date | 2023-11-10 |