NPI | 1922745074 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: SC 1761) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 33220) |
Enumeration Date | 2022-05-18 |
Last Update Date | 2022-11-21 |