NPI | 1821011438 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 23847) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 013359) |
Enumeration Date | 2006-07-25 |
Last Update Date | 2024-05-23 |