NPI | 1932394582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6865) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 23025) |
Enumeration Date | 2007-09-06 |
Last Update Date | 2012-02-27 |