NPI | 1679934871 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-12608) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MO 2015039823) |
Enumeration Date | 2016-03-15 |
Last Update Date | 2020-11-18 |