NPI | 1679853568 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 1697) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 129457) |
103TC0700X Psychologist, Clinical (Licence: KY 1697) | |
Enumeration Date | 2011-08-23 |
Last Update Date | 2020-04-22 |