NPI | 1497895767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 02557) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810001685) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 02557) | |
103T00000X Psychologist (Licence: VA 0810001685) | |
Enumeration Date | 2007-02-07 |
Last Update Date | 2011-12-30 |