NPI | 1225341696 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 3424) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019399) |
Enumeration Date | 2010-07-14 |
Last Update Date | 2021-02-09 |