NPI | 1821008947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MA 03502) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 03502) |
103TC1900X Psychologist, Counseling (Licence: MA 03502) | |
Enumeration Date | 2006-08-09 |
Last Update Date | 2014-12-29 |