NPI | 1104949924 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4483) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015843) |
Enumeration Date | 2007-04-08 |
Last Update Date | 2022-07-21 |