NPI | 1609919612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AR 92-25P) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 21056) |
Enumeration Date | 2007-02-15 |
Last Update Date | 2007-07-08 |