NPI | 1750521258 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: OR 1792) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic |
103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
103TP2701X Psychologist, Group Psychotherapy | |
Enumeration Date | 2009-02-24 |
Last Update Date | 2009-02-24 |