NPI | 1548310931 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20041058A) |
Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: KY 924) |
Enumeration Date | 2007-01-10 |
Last Update Date | 2007-07-08 |