NPI | 1144218645 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY4084) |
Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: FL PY4084) |
103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY4084) | |
103T00000X Psychologist (Licence: FL PY4084) | |
Enumeration Date | 2005-10-10 |
Last Update Date | 2007-07-08 |