NPI | 1639127558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 114440) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 0043) |
Enumeration Date | 2006-05-04 |
Last Update Date | 2020-11-18 |