NPI | 1598869778 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3296) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY0005168) |
Enumeration Date | 2006-09-11 |
Last Update Date | 2022-02-01 |