NPI | 1477670248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04014) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MD 04014) |
Enumeration Date | 2007-03-24 |
Last Update Date | 2007-07-08 |