NPI | 1396797213 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 103TA0700X Psychologist Adult Development & Aging |
Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
103TC0700X Psychologist Clinical | |
103TC2200X Psychologist Clinical Child & Adolescent | |
103TR0400X Psychologist Rehabilitation | |
Enumeration Date | 2006-05-17 |
Last Update Date | 2007-07-08 |