NPI | 1194958611 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04619) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 21591) |
Enumeration Date | 2009-09-01 |
Last Update Date | 2009-09-01 |