NPI | 1164575551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 01971) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 01971) |
103TF0000X Psychologist, Family (Licence: MD 01971) | |
Enumeration Date | 2007-01-19 |
Last Update Date | 2007-07-08 |