NPI | 1992776223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: UT 963262352501) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 963262352501) |
Enumeration Date | 2006-01-26 |
Last Update Date | 2008-03-17 |