NPI | 1366488710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 905) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 1394) |
Enumeration Date | 2006-06-22 |
Last Update Date | 2007-07-08 |