NPI | 1003951765 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004723) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3356) |
Enumeration Date | 2007-02-20 |
Last Update Date | 2013-05-16 |