NPI | 1881939585 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017295) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000922) |
Enumeration Date | 2012-12-06 |
Last Update Date | 2012-12-06 |