NPI | 1982097614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4564) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ 4564) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 4564) | |
103TC1900X Psychologist, Counseling (Licence: AZ 4564) | |
103TH0004X Psychologist, Health (Licence: AZ 4564) | |
Enumeration Date | 2015-03-04 |
Last Update Date | 2015-10-04 |