NPI | 1225192479 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY002625) |
Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: GA PSY002625) |
Enumeration Date | 2006-12-21 |
Last Update Date | 2007-09-18 |