NPI | 1922729474 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005508) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PR 006781) |
Enumeration Date | 2022-09-02 |
Last Update Date | 2022-09-02 |