NPI | 1366414781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0701001684) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000403) |
Enumeration Date | 2006-02-02 |
Last Update Date | 2007-07-08 |