NPI | 1639189566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810000862) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: SC 1025) |
Enumeration Date | 2006-08-09 |
Last Update Date | 2007-07-09 |