NPI | 1326274143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: LA 882) |
Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: LA 882) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: LA 882) | |
Enumeration Date | 2009-06-08 |
Last Update Date | 2011-12-06 |