NPI | 1881963700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 9039444-2501) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-1295) |
Enumeration Date | 2011-12-21 |
Last Update Date | 2022-04-13 |