NPI | 1740419514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA MA10824) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CT 002350) |
103TC0700X Psychologist, Clinical (Licence: CT CT002350) | |
Enumeration Date | 2009-07-14 |
Last Update Date | 2023-03-28 |