NPI | 1477582906 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: OR 400) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: OR 400) |
Enumeration Date | 2006-06-30 |
Last Update Date | 2007-07-08 |