NPI | 1245560176 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 01899) |
Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY 1398) |
103TC0700X Psychologist, Clinical (Licence: VA 0810001175) | |
Enumeration Date | 2009-12-25 |
Last Update Date | 2009-12-25 |