NPI | 1124451653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MO 2013032508) |
Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1299) |
Enumeration Date | 2013-08-20 |
Last Update Date | 2013-09-03 |