NPI | 1366639536 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2373) |
Additional Taxonomies | 101Y00000X Counselor |
103K00000X Behavior Analyst | |
Enumeration Date | 2007-10-01 |
Last Update Date | 2014-08-05 |