NPI | 1598976219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 363492-2501) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-903) |
Enumeration Date | 2007-05-24 |
Last Update Date | 2007-07-08 |