NPI | 1639728405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361007649) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6362005361) |
103TC0700X Psychologist, Clinical (Licence: MI 6301018082) | |
Enumeration Date | 2019-09-05 |
Last Update Date | 2021-10-06 |