NPI | 1811104243 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 495) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 495) |
Enumeration Date | 2007-05-16 |
Last Update Date | 2007-07-08 |