NPI | 1003901943 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301008669) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301008669) |
Enumeration Date | 2006-10-04 |
Last Update Date | 2014-04-11 |