NPI | 1881671386 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY0002507) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL SS33) |
Enumeration Date | 2005-12-27 |
Last Update Date | 2011-12-08 |