NPI | 1134138662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DE B1-0001104) |
Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5676) |
Enumeration Date | 2006-08-05 |
Last Update Date | 2018-02-13 |