NPI | 1487725834 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: WV WV936) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WV WV936) |
103TF0000X Psychologist, Family (Licence: WV WV936) | |
Enumeration Date | 2006-11-09 |
Last Update Date | 2016-08-30 |