NPI | 1902016843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY 5067) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MD 2091) |
Enumeration Date | 2007-05-22 |
Last Update Date | 2007-07-08 |