NPI | 1710102835 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: LA 919) |
Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: LA 919) |
103TB0200X Psychologist, Cognitive & Behavioral | |
Enumeration Date | 2007-04-16 |
Last Update Date | 2011-10-24 |