NPI | 1649302118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: OR 535) |
Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: OR 535) |
103TC0700X Psychologist, Clinical (Licence: OR 535) | |
Enumeration Date | 2007-03-11 |
Last Update Date | 2024-01-09 |