NPI | 1225102023 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: WV 271) |
Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: WV 00133) |
Enumeration Date | 2006-11-20 |
Last Update Date | 2007-07-08 |