NPI | 1457409765 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 02444) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000100) |
Enumeration Date | 2007-01-05 |
Last Update Date | 2007-07-08 |