NPI | 1841285079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY3931) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9101805) |
Enumeration Date | 2005-09-14 |
Last Update Date | 2022-01-18 |