NPI | 1003867490 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 015798) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 015798) |
103TP2701X Psychologist, Group Psychotherapy (Licence: NY 015798) | |
Enumeration Date | 2006-05-12 |
Last Update Date | 2016-07-20 |