NPI | 1306221411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: GA 003786) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MA 4286) |
Enumeration Date | 2015-07-30 |
Last Update Date | 2015-08-12 |