NPI | 1962453886 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301007101) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6801009627) |
Enumeration Date | 2006-05-15 |
Last Update Date | 2007-07-08 |