NPI | 1780635193 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3658) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AR 055P) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 3658) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AR 055P) | |
103TC0700X Psychologist, Clinical (Licence: AR 055P) | |
Enumeration Date | 2006-05-12 |
Last Update Date | 2012-02-21 |