NPI | 1609490234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301018412) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810005570) |
Enumeration Date | 2020-05-29 |
Last Update Date | 2020-06-17 |