NPI | 1013084672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY6222) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 0002317) |
Enumeration Date | 2006-11-29 |
Last Update Date | 2018-09-14 |