NPI | 1942348487 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 01189) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC Psy964) |
Enumeration Date | 2007-02-04 |
Last Update Date | 2007-07-08 |