NPI | 1598968349 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4093) |
Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: NC 4093) |
103T00000X Psychologist (Licence: SC 867) | |
Enumeration Date | 2007-06-08 |
Last Update Date | 2011-10-17 |