NPI | 1811078934 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810001811) |
Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: VA 0810001811) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2016-06-21 |