NPI | 1699730804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3334) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 3334) |
Enumeration Date | 2006-04-19 |
Last Update Date | 2022-07-21 |