NPI | 1194965970 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 019130) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 070791) |
Enumeration Date | 2009-03-06 |
Last Update Date | 2023-10-30 |