NPI | 1639297344 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: VT 048.0135139) |
Additional Taxonomies | 103T00000X Psychologist (Licence: UT 5729247-2501) |
Enumeration Date | 2007-03-27 |
Last Update Date | 2025-06-07 |