NPI | 1609087816 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 02179) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 02179) |
Enumeration Date | 2007-05-28 |
Last Update Date | 2007-07-08 |