NPI | 1700773900 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301019634) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301019634) |
Enumeration Date | 2025-06-20 |
Last Update Date | 2025-08-27 |