NPI | 1639605033 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: DC PSY1001395) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: LA 1556) |
103TC0700X Psychologist Clinical (Licence: NY 022075-1) | |
Enumeration Date | 2017-05-04 |
Last Update Date | 2020-12-14 |