NPI | 1942226725 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005907) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PR 2436) |
Enumeration Date | 2006-07-14 |
Last Update Date | 2024-04-02 |