NPI | 1043239668 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS-002053-L) |
Additional Taxonomies | 103TS0200X Psychologist School |
Enumeration Date | 2006-07-18 |
Last Update Date | 2008-01-08 |