NPI | 1760693956 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301011692) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI 6301011692) |
Enumeration Date | 2007-05-27 |
Last Update Date | 2007-07-09 |