NPI | 1669595617 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 2483) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 1000) |
103TC0700X Psychologist, Clinical (Licence: CA 6616) | |
Enumeration Date | 2007-04-06 |
Last Update Date | 2007-07-08 |