NPI | 1801165147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IA 130726) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071.009770) |
Enumeration Date | 2011-12-15 |
Last Update Date | 2025-04-28 |