NPI | 1609860881 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA PY 2853 PR) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MA PY 2853 PR) |
103TS0200X Psychologist School | |
Enumeration Date | 2005-09-02 |
Last Update Date | 2007-07-08 |