NPI | 1992885123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: MA 6570) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 6570) |
Enumeration Date | 2006-10-16 |
Last Update Date | 2010-03-23 |