NPI | 1922156405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP5153) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005759) |
103T00000X Psychologist (Licence: MN LP5153) | |
Enumeration Date | 2007-01-08 |
Last Update Date | 2024-10-03 |