NPI | 1396899100 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC #3120) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY 3989) |
Enumeration Date | 2007-01-22 |
Last Update Date | 2007-07-08 |