NPI | 1063747541 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 018339) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 018339) |
Enumeration Date | 2009-10-16 |
Last Update Date | 2013-02-13 |