NPI | 1104832781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 014548) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 14548) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2014-01-07 |