NPI | 1831193291 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1645) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY 100094) |
103TC0700X Psychologist, Clinical (Licence: MD 03750) | |
103TC0700X Psychologist, Clinical (Licence: AZ 3422) | |
103TC0700X Psychologist, Clinical (Licence: IA 001171) | |
103TC0700X Psychologist, Clinical (Licence: VA 0810002922) | |
Enumeration Date | 2005-06-13 |
Last Update Date | 2022-05-20 |