| NPI | 1528036761 |
|---|---|
| Former Name | ERIC JON GIBSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA HSP00445) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 00966) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IA HSP00445) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IA 00966) | |
| 103T00000X Psychologist (Licence: IA HSP00445) | |
| 103T00000X Psychologist (Licence: IA 00966) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |