NPI | 1366706434 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 05140) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000824) |
Enumeration Date | 2012-07-03 |
Last Update Date | 2012-10-18 |