NPI | 1699142851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 30168) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY003876) |
103TC0700X Psychologist, Clinical (Licence: MA 10161) | |
Enumeration Date | 2015-08-24 |
Last Update Date | 2018-08-07 |