NPI | 1376768028 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 01074) |
Additional Taxonomies | 103T00000X Psychologist (Licence: DC PFY1152) |
Enumeration Date | 2007-04-16 |
Last Update Date | 2007-07-08 |