NPI | 1639691124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9902) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00585700) |
103TC0700X Psychologist, Clinical (Licence: IN 20043231A) | |
Enumeration Date | 2017-07-17 |
Last Update Date | 2023-12-18 |