NPI | 1790801744 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA B10000101) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA B10000101) |
103TP2701X Psychologist, Group Psychotherapy (Licence: PA B10000101) | |
Enumeration Date | 2007-03-21 |
Last Update Date | 2007-07-08 |