NPI | 1407979206 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1890-057) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20040485A) |
Enumeration Date | 2007-04-08 |
Last Update Date | 2007-07-08 |