NPI | 1770834152 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 46745) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MS 46745) |
Enumeration Date | 2012-09-26 |
Last Update Date | 2012-09-26 |