NPI | 1346602729 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 00977) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 00977) |
Enumeration Date | 2016-03-24 |
Last Update Date | 2016-03-24 |