NPI | 1730260977 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA 573) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OR 412) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2009-07-06 |