NPI | 1700082583 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2241) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 2241) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 2241) | |
103TS0200X Psychologist, School (Licence: NC 2241) | |
Enumeration Date | 2007-06-27 |
Last Update Date | 2014-02-10 |