NPI | 1679395701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35451) |
Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA 35451) |
Enumeration Date | 2024-10-29 |
Last Update Date | 2024-11-06 |