NPI | 1275554842 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY4432) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS005069L) |
Enumeration Date | 2006-07-21 |
Last Update Date | 2007-07-08 |