NPI | 1790157188 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1560) |
Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: HI 1560) |
Enumeration Date | 2015-10-23 |
Last Update Date | 2015-10-23 |