NPI | 1427103886 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 682) |
Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: OR 682) |
103TF0200X Psychologist, Forensic (Licence: OR 682) | |
103T00000X Psychologist (Licence: OR 682) | |
Enumeration Date | 2007-01-24 |
Last Update Date | 2007-07-09 |