NPI | 1255391835 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TP2701X Psychologist Group Psychotherapy (Licence: FL MH3131) |
Additional Taxonomies | 103T00000X Psychologist (Licence: FL MH3131) |
Enumeration Date | 2006-03-27 |
Last Update Date | 2009-12-24 |