NPI | 1295938561 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NV PY0480) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY15951) |
Enumeration Date | 2007-06-06 |
Last Update Date | 2007-07-08 |