NPI | 1962526384 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: MD 02965) |
Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1685) |
Enumeration Date | 2007-03-19 |
Last Update Date | 2007-07-08 |