NPI | 1689705741 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2653) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: SC 0748) |
Enumeration Date | 2007-03-08 |
Last Update Date | 2007-07-08 |