NPI | 1457626038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 4277) |
Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1000398) |
Enumeration Date | 2012-03-15 |
Last Update Date | 2014-06-03 |