NPI | 1831201003 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810002997) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WV 870) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2008-05-29 |