NPI | 1982195632 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: MA 8833) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 8833) |
Enumeration Date | 2018-05-29 |
Last Update Date | 2018-05-29 |