NPI | 1801041082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1926) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 1926) |
103TF0200X Psychologist, Forensic (Licence: OR 1926) | |
Enumeration Date | 2008-12-01 |
Last Update Date | 2008-12-01 |