NPI | 1801224332 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1734) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NM 313091) |
Enumeration Date | 2013-10-18 |
Last Update Date | 2022-10-13 |