NPI | 1891264313 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06186) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810-006038) |
Enumeration Date | 2018-11-14 |
Last Update Date | 2018-11-14 |