NPI | 1124157599 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 1680) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: SC 550) |
Enumeration Date | 2007-03-03 |
Last Update Date | 2007-07-08 |