NPI | 1861948606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: TX 38756) |
Additional Taxonomies | 103T00000X Psychologist (Licence: TX 38756) |
103T00000X Psychologist (Licence: NY 024647) | |
Enumeration Date | 2016-08-31 |
Last Update Date | 2024-09-04 |