NPI | 1689669038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN 2386) |
Enumeration Date | 2005-09-13 |
Last Update Date | 2025-04-29 |