NPI | 1295940096 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NY 6406) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CT 2456) |
Enumeration Date | 2007-05-14 |
Last Update Date | 2007-07-08 |