NPI | 1568781847 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017123) |
Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6588) |
Enumeration Date | 2010-05-25 |
Last Update Date | 2012-06-14 |