NPI | 1104871086 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 002812) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016654-1) |
Enumeration Date | 2006-05-23 |
Last Update Date | 2009-05-06 |