NPI | 1760591333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: VT 0480000264) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NC 0645) |
103T00000X Psychologist (Licence: FL PY5922) | |
Enumeration Date | 2006-08-29 |
Last Update Date | 2007-07-08 |