NPI | 1093114464 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 021931) |
Additional Taxonomies | 103T00000X Psychologist (Licence: TX 40079) |
103T00000X Psychologist (Licence: FL TPPY2475) | |
Enumeration Date | 2014-08-21 |
Last Update Date | 2023-12-06 |