NPI | 1952370942 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KS 1372) |
Additional Taxonomies | 103T00000X Psychologist (Licence: AK 492) |
103T00000X Psychologist (Licence: MO 2005036331) | |
Enumeration Date | 2006-03-14 |
Last Update Date | 2019-03-25 |