NPI | 1235295395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 5022) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 5022) |
Enumeration Date | 2006-12-30 |
Last Update Date | 2007-08-16 |