NPI | 1861513186 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DE 0000752) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DE 0000752) |
Enumeration Date | 2007-04-03 |
Last Update Date | 2007-07-08 |