NPI | 1720024821 |
---|---|
Other Name | GENE SHOOTER, JR. |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 00810002612) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1878) |
103TC0700X Psychologist, Clinical (Licence: HI PSY518) | |
Enumeration Date | 2006-06-20 |
Last Update Date | 2008-03-06 |