NPI | 1538252549 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301006289) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6301006269) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2007-07-08 |