NPI | 1295847002 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1817-057) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: WI 43715) |
103T00000X Psychologist (Licence: WI 1817-057) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: WI 1817-057) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2007-07-09 |