NPI | 1891739330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS004575L) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS004575L) |
Enumeration Date | 2006-06-15 |
Last Update Date | 2016-06-13 |