NPI | 1215583166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 024443) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 024443) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-08-16 |
Last Update Date | 2022-06-25 |