NPI | 1780624437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1307) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NC 1307) |
103TC0700X Psychologist, Clinical (Licence: NC 1307) | |
Enumeration Date | 2006-06-08 |
Last Update Date | 2013-06-17 |