NPI | 1699244509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3354) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-1825) |
Enumeration Date | 2018-11-20 |
Last Update Date | 2025-10-14 |