NPI | 1225222433 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY316) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY3208) |
Enumeration Date | 2007-08-30 |
Last Update Date | 2012-08-15 |