NPI | 1669465993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 129106) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 842) |
Enumeration Date | 2005-08-23 |
Last Update Date | 2023-04-09 |