NPI | 1003896705 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY 9208) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NC 3122) |
Enumeration Date | 2006-01-19 |
Last Update Date | 2014-12-10 |