NPI | 1447389333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MI 6301002233) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301002233) |
Enumeration Date | 2007-03-05 |
Last Update Date | 2007-07-08 |