NPI | 1437172475 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2010036986) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KS 1918) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 6155) | |
Enumeration Date | 2006-07-25 |
Last Update Date | 2011-09-02 |