NPI | 1669783718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: OR 2053) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2053) |
Enumeration Date | 2010-06-23 |
Last Update Date | 2011-07-21 |