NPI | 1801093679 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4691) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NC 4691) |
Enumeration Date | 2007-06-27 |
Last Update Date | 2021-11-08 |