NPI | 1497795488 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 533) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MS 6-79) |
Enumeration Date | 2006-06-07 |
Last Update Date | 2007-07-08 |