NPI | 1801123443 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000601) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS003665L) |
Enumeration Date | 2009-11-03 |
Last Update Date | 2009-11-03 |