NPI | 1952855058 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY11148) |
Additional Taxonomies | 103T00000X Psychologist (Licence: FL PsyPact.9853) |
103T00000X Psychologist (Licence: CO PSY.0005601) | |
103T00000X Psychologist (Licence: KS LP03427) | |
Enumeration Date | 2016-08-08 |
Last Update Date | 2025-04-16 |