NPI | 1881731685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 202267) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 15944) |
103TC0700X Psychologist, Clinical (Licence: CO 3097) | |
Enumeration Date | 2007-01-31 |
Last Update Date | 2023-02-13 |