NPI | 1821008855 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 33048) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MT 312) |
Enumeration Date | 2006-08-09 |
Last Update Date | 2007-07-08 |