NPI | 1972528917 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS005995L) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS005995L) |
Enumeration Date | 2006-07-12 |
Last Update Date | 2012-02-02 |