NPI | 1699059493 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000719) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC 1000719) |
Enumeration Date | 2011-09-28 |
Last Update Date | 2025-02-25 |