NPI | 1740999515 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NC 6066) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS019417) |
Enumeration Date | 2022-11-21 |
Last Update Date | 2022-11-21 |