NPI | 1811693351 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY203864) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP6892) |
Enumeration Date | 2023-02-06 |
Last Update Date | 2024-08-14 |