NPI | 1669427639 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 007389) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MI 007389) |
103TF0000X Psychologist, Family | |
Enumeration Date | 2006-05-24 |
Last Update Date | 2024-04-04 |