NPI | 1366461014 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 03714) |
Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: MD 3714) |
103TC0700X Psychologist Clinical (Licence: VA 0810003695) | |
Enumeration Date | 2006-07-19 |
Last Update Date | 2008-11-05 |