NPI | 1710027099 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME 803) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4851) |
103TC0700X Psychologist, Clinical (Licence: RI 427) | |
Enumeration Date | 2007-02-07 |
Last Update Date | 2007-07-08 |