NPI | 1023071172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY5073) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 3017) |
Enumeration Date | 2006-04-10 |
Last Update Date | 2007-07-08 |