NPI | 1750592267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 861) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MD 861) |
103TC0700X Psychologist, Clinical (Licence: MD 861) | |
Enumeration Date | 2007-05-25 |
Last Update Date | 2015-04-02 |