NPI | 1669462669 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 722) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 2316) |
Enumeration Date | 2005-10-21 |
Last Update Date | 2007-07-08 |