NPI | 1629087564 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 7970) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS00803) |
Enumeration Date | 2006-08-07 |
Last Update Date | 2007-07-09 |