NPI | 1437318342 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 1255) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CO 1255) |
103TB0200X Psychologist Cognitive & Behavioral (Licence: CO 1255) | |
Enumeration Date | 2008-06-05 |
Last Update Date | 2008-06-05 |