NPI | 1578779534 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 1865) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 3381) |
Enumeration Date | 2007-05-15 |
Last Update Date | 2007-07-08 |