NPI | 1346286689 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS004602L) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS004602L) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS004602L) | |
Enumeration Date | 2006-06-22 |
Last Update Date | 2014-01-24 |