NPI | 1376755850 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 03589) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 2824) |
Enumeration Date | 2007-05-04 |
Last Update Date | 2009-08-18 |